No More Epinephrine Ratios

Cocchio reported, “starting May 2016, the ratio expression format for certain single-entity drug labels will no longer be permitted.[1]” Current inventory will remain until they’re depleted.

He stated, labels for epinephrine will all be required to include mass concentrations, like most every other drug. This change will not include labels for local anesthetics like lidocaine 1% and epinephrine combination solutions. Evidently, there has been confusion related to epinephrine ratio expressions (1:10,000 vs 1:1000) which, over the years has caused dosing errors and led to serious harm. [2-8]

The new epinephrine labeling will only be displayed as the mass concentration format. For example, epinephrine 1:1000 injection will now be labeled as 1 mg/mL, while epinephrine 1:10,000 injection will be labeled as 0.1 mg/mL. I think this would be a perfect time to provide epinephrine 0.01 mg/ml for push-dose administration.

Certainly, this change will not prevent all epinephrine errors, but it may help reduce their incidence.

Craig Cocchio, PharmD, BCPS, is an Emergency Medicine Clinical Pharmacist at Trinity Mother Frances Hospital in Tyler, Texas. Follow on Twitter @iEMPharmD and on his blog at empharmd.blogspot.com